Study On The Safety Of Drainage Tube Placement And The Time Limit Of Early Clipping After Primary Unilateral Total Knee Arthroplasty

Aim:This study aim to explore the safety of drainage tube placement and the time limit of early clipping after primary total knee arthroplasty(TKA).Methods:From January 1,2016 to January 1,2018,200 patients with OA in our hospital were selected,including 52 males and 148 females.The medial parapatellar approach was used in all patients with TKA.According to the purpose of this experiment and the condition of TKA operation,200 patients with OA were randomly divided into five groups,40 cases in each group.Group A: early clamping for 1 hour after TKA;Group B: early clamping for 2 hours after TKA;Group C: early clamping for 3 hours after TKA;Group D: early clamping for 4hours after TKA;Group E: no placement of drainage tube after TKA;Injecting of 1 g tranexamic acid mixed with 30 mL saline into knee joint.All the prostheses are Link's PS prostheses.Total blood loss,drainage volume,Hb content,lower limb circumference,knee incision healing,subcutaneous ecchymosis,Range of Motion(ROM),Hospital for Special Surgery Knee Score(HSS)and Visual Analog Scale(VAS)were recorded,as well as the complications after TKA(deep vein thrombosis of lower extremities,skin infection of knee joint,etc).Result:(1)There was no significant difference in baseline data such as sex,age,height,weight and BMI between the five groups(P>0.05).(2)There was no significant difference in hemoglobin before operation,1 day after operation,3 days after operation and 7 days after operation(P>0.05).(3)There was no significant difference in hematocrit between the five groups before operation,1 day after operation,3 days after operation and 7 days after operation(P>0.05).(4)There was no significant difference in limb circumference between the five groups before and 7 days after operation(P>0.05).There was significant difference in the circumference of affected limbs between the 5 groups on the 1 day and the 3 day after operation(P<0.05).The circumference of affected limbs in group E was significantly larger than that in group A,group B,group C and group D on the 1 and 3 day after operation(P<0.05),The circumference of affected limbs in group B was significantly smaller than thatin group A,group C,group D and group E on the 1 and 3 day after operation(P<0.05).(5)There was no significant difference in total blood loss and transfusion rate between the five groups(P>0.05).The total drainage volume in group A was significantly higher than that in group B,group C and group D(P<0.05);However,there was no significant difference in the total drainage volume between group B,group C and group D(P>0.05).(6)There was no significant difference in knee joint motion between the five groups before and 7 days after operation(P>0.05).There was significant difference in knee joint activity between the five groups on the 1 and 3 day after operation(P<0.05).The knee joint activity of affected limbs in group E was significantly lower than that in group A,group B,group C and group D(P<0.05),but there was no significant difference in the knee joint activity of affected limbs between group A,group B,group C and group D on the 1day and 3 day after operation(P>0.05).(7)There was no significant difference in VAS scores of affected limbs and knees between the five groups before and 7 day after operation(P>0.05).There was significant difference in VAS score of affected knee joint between the 5 groups on the 1 day and the 3day after operation(P<0.05).The VAS score of affected knee joint in group E was significantly higher than that in group A,group B,group C and group D(P< 0.05),but there was no significant difference in VAS score of affected knee joint between group A,group B,group C and group D on the 1 day and 3 day after operation(P>0.05).(8)There was no significant difference in HSS scores of affected limbs and knees between the five groups before and 7 day after operation(P>0.05).There was significant difference in HSS scores of affected limbs and knees between the five groups on the 1 day and the 3 day after operation(P<0.05).HSS scores of affected knee joint in group E were significantly higher than those in group A,group B,group C and group D on the 1 day and 3 day after operation(P<0.05);However,HSS scores of affected knee joint in group A,group B,group C and group D on the 1dat and 3 day after operation had no statistical difference(P>0.05).(9)The incidence of tension blisters and the subcutaneous congestion as well as ecchymama in the 5 group was significant difference(P<0.05);The incidence of tension blisters in group E was higher than that in group A,group B,group C and group D(P<0.05).The incidence of the subcutaneous congestion and ecchymama in group B was lower than that in group A,group C,group D and group E(P<0.05)There was no significant difference between incision infection and DVT.Conclusion:(1)It is recommended to place drainage tube after TKA.(2)The early clamping time of drainage tube after TKA operation is 2 hours.